Referring Your Clientele for Aquatic Exercise Programs

Aquatic exercise can be very beneficial for a varietywater, heart rates on average are decreased 13% or
of patients: seniors, athletes needing injury17 bpm from those on land.
rehabilitation, and pregnant women are just a few of¨ Intensity must also take into account the
the groups that aquatic exercise can benefit. Feweffects of medications or specific disease conditions.
practitioners know what to look for when they refer¨ To increase the heart rate, use shorter levers
their patients to an aquatic exercise program, though.and less elevation of movements.
Most usually tell their patients to "join a water¨ Using the arms overhead increases the heart
aerobics class" and leave it at that, without reallyrate, but not the stroke volume, so the cardiac
knowing what the patient may be getting into. Belowoutput may not be enough to achieve cardiovascular
are some of the things health practitioners shouldfitness.
consider when referring their patients for aquatic¨ You cannot use sweat to correlate to exercise
exercise.intensity. You may sweat in the water without
Referring Patients for Aquatic Exerciseknowing it.
¨ Observe classes in your area.¨ New exercisers must be taught the difference
¨ Know the pool temperature. (86º orbetween "bad pain" and "good pain" (from exercising).
higher for arthritics, 79-82º for lap swimming)Aquatic Exercise and Pregnancy
¨ Know the special needs accessibility of the¨ Benefits of aquatic exercise during pregnancy:
pool and locker rooms¨ decreased impact.
¨ Check on third party payer reimbursement.¨ decreased gravitational pull.
¨ Think of your patient. Would you send a¨ cooling effect of water prevents overheating.
70-year-old to a class at a mirror-clad health club, or¨ heart rate doesn't increase as much as with
to a YMCA? Does a 20-year-old athlete need to be inland exercise.
an Arthritis Foundation level class?¨ hydrostatic pressure pushes excess fluid into
Safety Issuesthe bloodstream, decreasing edema.
¨ Is a lifeguard present?¨ less of a heavy, clumsy feeling in the water.
¨ How comfortable is the patient in the water?¨ feel like they can move with more grace.
¨ Is there food available in the area for diabetics¨ Safer.
if necessary?¨ Emphasize simply maintaining their current
¨ Is there a first aid kit?fitness level instead of trying to improve it.
¨ Is there a backboard?¨ Pregnancy may be the first time she considers
¨ Is there a phone?fitness, so she may need more feedback from the
¨ Is there a defibrillator on the premises?instructor.
¨ Are the instructor and lifeguard aware of your¨ Special needs for pregnant patients in aquatic
patient's particular problem?exercise:
Aquatic Exercise Design¨ longer warm-up and cool-down
¨ Water affects each body type/design/fat¨ gradual intensity changes and longer transition
distribution differently. For example, males will have atimes
harder time in deeper water than will females due to¨ simple choreography
wider shoulders and narrower hips. Pear-shaped¨ caution against overstretching
patients will have a harder time keeping their legs¨ good chance to educate on proper nutrition
from floating, due to their fat distribution, so they willand hydration
need to exercise more abdominal control.¨ Pregnant women can safely perform supine
¨ The same exercise will work different muscles,abdominal exercises in the water because there is no
depending on the depth of the water.pressure on the vena cava like there would be on
¨ Changing the speed of the exercise changesland. (Must check for diastasis recti, though.)
the amount of friction, which changes the resistance.¨ Intensity should reflect how they feel today,
¨ Currents change proprioception, stability, andnot how they "usually" exercise.
level of control.¨ If a pregnant woman is in a mixed class, do
¨ Water at neck level supports 90% of thenot single her out. Talk to her about special
body's weight; water at mid-torso level supportsprecautions either before or after class.
75% of the body's weight, and water at waist levelStrength Training in the Water
supports 50% of the body's weight. How deep the¨ Of all the body systems, the
patient should be depends on their individual needs.neuromusculoskeletal system can demonstrate the
¨ In most aquatic exercises, there is frequentmost visibly dramatic difference between a
use of the abdominals to maintain position, withoutcompletely sedentary person and a person who
doing sit-ups/crunches.conscientiously trains.
¨ Emphasize posture and body position to get¨ A 1990 study of 86-96 year olds in long term
the most benefit from aquatic exercise.care facilities with only 8 weeks of aquatic strength
¨ Start easy to avoid discouragement.training to their knee extensors there was an
Intensity of Aquatic Exerciseaverage strength increase of 180%. Some subjects in
¨ Intensity should not be based on heart rate.the study were even able to eliminate their use of
Heart rates are only valid of they correlate tocanes when walking.
oxygen consumption. Heart rates will be lower in the¨ Aquatic strength training does not increase the
water because water dissipates heat morenumber of muscle fibers, but does increase their size,
effectively than air, so the heart doesn't beat as fastthe number of fibers activated, the number of
to cool the body; decreased gravitational pull easescapillaries going to the muscle fibers, and the
venous return; and hydrostatic effects shift bloodmitochondrial efficiency in the muscles.
volume from the extremities to the thorax. In the